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Query: UMLS:C0002395 (Alzheimer's disease)
 110,584 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the first part of this paper we discuss some of the most important areas of progress and of controversy in the field of memory functions and of memory impairment. Three main issues are taken separately into account: (1) the fractionation of memory into a number of sub-systems and the relationships existing among these subsystems; (2) the main theories of amnesia and the mechanisms underlying memory disorders; (3) the main anatomoclinical forms of amnesia and the brain structures subserving various components of the amnesic syndrome. In the second part we shift from the basic research to the clinically oriented investigations, reporting the results of two studies that we have recently conducted on some aspects of memory disorders in dementia. In the first study we have shown that severity and qualitative aspects of amnesia can be used to distinguish the two most frequent clinical forms of dementia, namely the dementia of the Alzheimer's type (DAT) from the vascular forms of dementia. In the second study we have demonstrated that a fine grained analysis of memory impairment can help improving the most difficult differential diagnosis in this field, namely the distinction between DAT and depressive pseudo-dementia.
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PMID:Progress and controversies in neuropsychology of memory. 129 98

Young and aged rats were subjected to cerebrovascular insufficiency (CVI) for 3 and 9 weeks. At the end of each time period, local cerebral blood flow (lCBF), spatial memory function, 31P- and 1H-NMR spectroscopy and imaging of the brains were evaluated in vivo. Morphometric counts of CA1 hippocampal neuron damage and staining for glial fibrillary acidic protein (GFAP) were done post-mortem. Results show that after 3 weeks of CVI, cortical and hippocampal lCBF was significantly reduced in young and aged animals respectively. In addition, young and aged rats at 3 weeks following CVI showed spatial memory deficits in the Morris water maze and elevation of 31P-phosphomonoester as measured by non-invasive NMR spectroscopy. At the same time period, in vivo 1H-microimaging (MRI) of brains showed areas of high signal intensity (suggesting local edema) localized asymmetrically to the right hippocampal region in young and aged CVI rats. Morphometry of the hippocampal CA1 sector at post-mortem confirmed the in vivo MRI changes and demonstrated that a significant percentage of the CA1 pyramidal cells were damaged after CVI. Nine weeks after CVI, hippocampal CBF reductions, spatial memory impairment, spectroscopic-microimaging changes and CA1 sector cell damage continued to be observed in the aged animals but were resolved in the young rat brains. In addition, GFAP immunoreaction progressively increased in the hippocampus of aged rats subjected to CVI for 9 weeks. It is concluded that cognitive, metabolic and morphologic damage was significantly more severe and longer lasting in aged than young rat brain after chronic CVI. The deficits observed in this rat model appear to mimic the early pathology reported in Alzheimer's disease and suggest that the present model could provide fundamental clues relative to the etiology and possible management of this dementia.
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PMID:Chronic cerebrovascular insufficiency induces dementia-like deficits in aged rats. 132 2

The course of decline was studied in 16 patients with probable or definite dementia of the Alzheimer type (DAT) over 2.7 to 6.8 years from first to last evaluation. Overall severity of dementia was measured with the Wechsler Adult Intelligence Scale (WAIS), the Dementia Rating Scale (DRS), and the Mini-Mental State Examination (MMSE), at approximately annual intervals. An initial plateau phase, during which language and cognitive functions did not change for periods of 9 to 35 months, was observed in 5 patients who initially had an isolated memory impairment without significant impairment of nonmemory language or visuospatial function. Once nonmemory functions began to decline, the rate of decline was remarkably steady in most individual patients but varied markedly among patients. The initial rate of decline after the plateau phase, as measured with the WAIS and DRS, was a significant predictor of subsequent rate in individual patients (r = .66, p less than .01, and r = .67, p less than .01, for the WAIS and DRS, respectively). The MMSE was a less reliable measure of longitudinal change in dementia severity and did not predict future rates of decline (r = .29). These results demonstrate a biphasic trajectory of decline in patients with DAT. Stable interindividual differences in rate of decline may provide a basis for designing more sensitive studies of treatments intended to slow or halt the progress of DAT.
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PMID:Individual trajectories of cognitive decline in patients with dementia of the Alzheimer type. 140 Sep 20

We determined the rates of lateral ventricular enlargement and decline in cognitive performance for 11 men and nine women with dementia of the Alzheimer type (DAT), and compared these rates with the same measures obtained for age-matched healthy controls (nine men and eight women). DAT patients, as a group, had only mild cognitive impairment at initial evaluation, and each patient was followed from 9 months to over 7 years with yearly evaluations. Six DAT patients had isolated memory impairment as their only cognitive deficit early in the course of the disease. The rate of total lateral ventricle enlargement (cm3/yr) was significantly different between DAT and healthy controls, and was more specific and sensitive to the diagnosis of DAT than comparison of cross-sectional volumes at final evaluation. The rate of total lateral ventricular enlargement did not differ significantly by patient sex, ventricular size at initial evaluation, age, or degree of cognitive impairment as measured by Mini Mental State Examination scores. However, in the six DAT patients initially found to have isolated memory impairment, the rate of ventricular enlargement during the period of isolated memory impairment was significantly less than the rate of ventricular enlargement after the onset of nonmemory cognitive impairment. The diagnostic power of total lateral ventricular measures made from two CTs separated by 1 year and obtained early in the course of the illness, however, was only 0.33. We conclude that the total lateral ventricular enlargement accompanying DAT is due to continuous, pathologic cell loss, significantly greater than cell loss due to the healthy aging process.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Longitudinal changes in lateral ventricular volume in patients with dementia of the Alzheimer type. 140 87

With life spans increasing the number of demented people rises steeply which requires proper diagnosis, particularly in the early stage of the disease. Although the majority of patients suffering from dementia have Alzheimer's disease characterized by slowly progressive course, searching for treatable causes will enable effective support to a certain number of patients. Presence of only one clinical symptom and/or sign, like the memory impairment is not sufficient for diagnosing dementia owing to its nonspecificity. Proper diagnosis depends upon one's familiarity with the criteria, clinical features, associated symptoms and the natural course of the disease as well as a wide variety of different etiological factors manifested by the similar clinical picture. In spite of certain shortcomings, the flow chart system approach of diagnostic procedure is intended for more accurate and less time consuming assessment of the clinical diagnosis of dementia. Understanding and familiarity with different aspects of the clinical picture lie behind the rational approach and selection of various laboratory methods and techniques to confirm or exclude presence of the disease for the benefit of patients and to avoid unnecessary wasting of considerable amounts of financial resources.
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PMID:Assessment of dementia flow chart approach to clinical diagnosis. 146 99

Early referral for specialist assessment is becoming more common with memory disorders and dementia: the mean Mini-Mental State Examination (MMSE) score of new patients at our clinic rose from 18.7 to 20.7 between 1986 and 1990. The clinical diagnosis of mild to moderate dementia has been recognized to be difficult, but several studies have reported cross-sectional diagnosis. We examined the number of visits required to establish a clinical diagnosis of dementia in the first 125 patients attending a Memory Disorders Clinic who had at least two visits (six months apart) and the stability of the diagnoses. Just under half of the patients required at least two visits to establish the clinical diagnosis. The MMSE was not a good guide to the number of visits required but the diagnosis at the first visit remained stable in all patients who scored < or = 10/30. Sixteen per cent of patients interchanged between the categories of Alzheimer's, mixed and vascular dementias. Possible age-associated memory impairment progressed to dementia in six of eight cases, and depression to dementia in three cases. The diagnosis of mild to moderate dementia should not be restricted to a cross-sectional approach, but should involve serial clinical, psychological and affective assessments.
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PMID:Longitudinal diagnosis of memory disorders. 147 75

The investigation of patients with Alzheimer's disease was based on the following questions: which symptoms occur at onset, which cognitive, non cognitive and neurological symptoms already appear in early stages of the disease and how frequent are they? Memory impairment was the most frequent symptom at onset. However apathy and deficits in word finding did also occur at the beginning of the disease' clinical manifestation. It is generally suggested that symptoms in mild Alzheimer's disease are confined to impairment of memory, orientation, and language. In contrast to that our results suggest that psychopathological symptoms in mild Alzheimer's disease may cover a wide range of cognitive and non cognitive deficits.
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PMID:[Psychopathologic disorders at the onset of Alzheimer's disease]. 154 18

The clinical correlates of hypothalamic-pituitary-adrenal (HPA) functioning were examined in 29 patients with probable Alzheimer's disease. The 8:00 a.m. postdexamethasone cortisol levels of these patients were highly correlated with higher agitation scores but not with the degree of depressed mood or memory impairment. The possible neural basis for the association between hypercortisolism and behavioral disturbance in Alzheimer's disease warrants further exploration and replication.
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PMID:Agitation and postdexamethasone cortisol levels in Alzheimer's disease. 155 44

Glucose utilization appears to play a role in memory, and patients with Senile Dementia of the Alzheimer Type (SDAT) show particular abnormalities of the glucose system. The present study examined the effects of glucose administration on memory in subjects with mild SDAT and age-matched controls. SDAT subjects demonstrated greater overall increases in blood glucose levels following glucose administration. Normal subjects whose blood glucose levels returned to near baseline following glucose administration showed facilitated memory performance, whereas SDAT subjects whose blood glucose levels remained elevated showed significant improvement following glucose administration. The results suggest that impaired glucose regulation contributes to memory impairment in SDAT.
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PMID:Glucose and memory in mild senile dementia of the Alzheimer type. 157 48

Recent advances in the ability to study brain anatomy and function and attempts to link these findings with human behavior have captured the attention of the legal system. This had led to the increasing use of the "neurological defense" to support a plea of not guilty by reason of insanity. This article explores the history of the insanity defense and explores the role of the medical expert witnesses in integrating clinical and laboratory findings, eg, computed tomographic scans, magnetic resonance scans, and single-photon emission computed tomographic scans. Three cases involving murder and brain dysfunction are discussed: the first case involves a subarachnoid hemorrhage resulting in visual perceptual and memory impairment; the second case, a diagnosis of Alzheimer's disease; and the third case, the controverted diagnosis of complex partial seizures in a serial killer.
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PMID:Murder, insanity, and medical expert witnesses. 159 96


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